Permit CITY TIGARD PLUMBING PERMIT
F DEVELOPMENT SERVICES PERMIT #: PLM2005 -00531
13125 SW Hall Blvd., Tigard, OR 97223 503 - 639 -4171 DATE ISSUED: 10/27/2005
PARCEL: 1 S 126DC -03000
SITE ADDRESS: 09314 SW LEHMAN ST ZONING: R -5
SUBDIVISION: LEHMANN ACRE TRACT LOT: 008 JURISDICTION: TIG
Project Description: Site utilities for minor land partition.
CLASS OF WORK: OTR GARBAGE DISPOSALS: MOBILE HOME SPACES:
TYPE OF USE: COM WASHING MACH: BACKFLOW PREVNTRS:
OCCUPANCY GRP: FLOOR DRAINS; TRAPS:
STORIES: WATER HEATERS: CATCH BASINS: 1
FIXTURES LAUNDRY TRAYS: SF RAIN DRAINS:
SINKS: URINALS: GREASE TRAPS:
LAVATORIES: OTHER FIXTURES:
TUB /SHOWERS: SEWER LINE: 0 ft
WATER CLOSETS: WATER LINE: 408 ft
DISHWASHERS: RAIN DRAIN: 335 ft
Owner: FEES
DALE RICHARDS Description Date Amount
12655 SW NORTH DAKOTA
TIGARD, OR 97223 [PLUMB] Permit Fee 10/27/200E. $434.80
[PLMPLN] Plan Review 10/27/200E $108.70
Phone : 503-780-4375 [TAX] 8% State Surcharp 10/27/200` $34.78
Total $578.28
Contractor:
NEW WEST CONSTRUCTORS INC
PO BOX 19588 REQUIRED ITEMS AND REPORTS
PORTLAND, OR 97280 -2909
Phone : 503- 977 -2909
Reg #: LIC 105212
PLM 26 -783PB
This permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes
and all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is
not started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law
• require :. = ollow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR
952 -► 801- 0010th .ugh OAR 952 - 0001 -0100. You may obtain copies of these rules or direct questions to OUNC by
calli g 503 - 246 -669' or 1 -80Il •
lssu: d By: 1 � �r Jam. !ri Permittee Signature:
Call 503 - 639 -4175 by 7:00 a.m. for an inspection that business day.
This permit card shall be kept in a conspicuous place on the job site until completion of the project.
Approved plans are required on the job site at the time of each inspection.
•
r - -� T 6
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Site Utilities t.
Plumbing P.rmit Application FOR,OFFICE USE ONLY
• City of Tigard E f ® Received I V
V Permit No
_
•
Date/By l p i I Lt. - - -i e� '00 5
13125 SW Hall Blvd., Tigard, 01:947,_.,.., plan Review
Phone: 503.639.4171 Fax: 503.598.1960 / /yir g ::Nr, ; '� j- D O Permit o
h Date /B cJ i -. i'j� / �/
24- Hour Inspection Line: 503.639.4CeJ 1 0 2005 I.'�I y I N
Date Ready/By: H See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: Supplemental Information
WPP OF icSORSID • FEE* SC II I ULE .
d New construction BUILDING D fjSQ>mlolition For special information use checklist.
Description I Qty. I Ea. I Total
❑ Addition /alteration/replacement ❑ Other: New 1-2-family dwellings (includes 100 ft. for each utility connection)
. CATEGORY OF CONSTRUCTION SFR (I) bath 249.20
❑ 1- and 2- family dwelling ❑ Commercial /industrial SFR (2) bath 350.00 .
El Accessory building ❑ Multi - family SFR (3) bath 399.00
� � Each additional bath/kitchen 45.00
ID Master builder Other: S• ` le: (f 1-i I t I f Fire sprinkler ( sq. ft.) Page 2
:JOB SITE' INFORMATION AND LOCATION Site utilities
Job site address: 9311' p S ( /. _L,, h, a vk S1 - i Catch basin or area drain / 16.60
City /State /ZIP: r; U.P- .f / ®f o`r, , 7$1 ie►c Drywell, leach line, or trench drain 16.60
Suite/bldg./apt. no.: �/ tQ l Project am �� t Footing drain (no. linear ft.: ) Page 2
tyke.. ✓l ®o0. r - fi !o A
f Manufactured home utilities 110.00
Cross street /directions to job site: / Manholes 16.60
St/O, 1 2,,,,d , A $ 1, txAYt P0. 7�rc " Rain drain connector 16.60
Sanitary sewer (no. linear ft.: ) Page 2
Storm sewer (no. linear R.: 3 5 Page 2 /i
Subdivis ion: �� ,1 ti pa.r l / /_ S . Lot no.: Water service (no. linear ft.: YOB) Paget y � i
Fixture or item
Tax map /parcel no.: I.S I 2,6 0300d Absorption valve 16.60
DESCRIPTION OF WORK Backflow preventer Page 2
Q
S ; - s - ve, I op t--ca- t"- i 41, C1u.43 t .. 4,40 rv. Sep to ri Backwater valve 16.60
Wa ,tk 4 n it-w• i S�f #1,; i� , - Wer Clothes washer 16.60
Dishwasher 16.60
Drinking fountain 16.60
P ROPERTY OWNER I . . ❑ TENANT
•
R t _ .. rc �r Ejectors sump 16.60
Name: M , ,- . OA . t
N �C�l� w a a�ot Ho �S • Expansion tank 16.60
Address: I � �S S W. No rt✓ A Dei.,+c S Fixture /sewer cap 16.60
City /State /ZIP: 2- Floor drain /floor sink/hub 16.60
71yar dr �1•, X 3
1
Phone: (raj ) `'. 8& [f3 7s Fax: (5O3 )L0 7 )( Garbage disposal 16.60
Hose bib 16.60
LI APPLICANT ❑ CONTACT PERSON
ll Ice maker 16.60
Business name: ,j .t �,t,I.retitaS &, /Assoc. c . Interceptor /grease trap 16.60
Contact name: Medical gas (value: $ ) Page 2
Address: Primer 16.60
City /State /ZIP: Roof drain (commercial) 16.60
Phone: ( ) I Fax: : ( ) Sink /basin/lavatory 16.60
Tub /shower /shower pan 16.60
E -mail: •
Urinal 16.60
CONTRACTOR Water closet 16.60
Business name: e4-0 � o / + Cow,: 41 de Rs. /� C- • Water heater 16.60
Address: � f�� ' k 1 q 5 g Other:
City /State /ZIP: pY� ` q'- a.H Subtotal
C • Minimum permit fee: $72.50 ,/2 JO
Phone: (5-03) g 6 3777 Fax: (,Sc3) (' 712.8 ZO Residential backflow minimum permit fee: $36.25 / r 7 n
Plan review (25% of permit fee) -
CCB Lic.: j(�5 '!J� -Plumbing Lic. no 'F��ij"l�� / __ / I_ -, - _
�/ • State surcharge (8% of permit fee) i -
Authorized signature: TOTAL PERMIT FEE 'IT ,
• Print name: 6 r , r�h� '
Z Date: / p / /d/ J `� This permit application expires if a permit is not obtained within
Y f !! 180 days after it has been accepted as complete.
*Fee methodology set by Tri- County Building Industry Service Board.
i:\ Building \Pernits\PLMU- PermitApp.doc 06/05 440- 4616T(10 /02/COM/WEB)
Plumbing Permit Application - City of Tigard
Page 2 - Supplemental Information
Fee •Schedule: - . • Residential Fire Suppression Systems:
Site Utilities • Qty. Fee (ea) Total Square Footage: Permit Fee: •
Footing drain - 1' 100' 55.00 0 to 2,000 $115.00
Footing drain - each additional 100' 46.40 2,001 to 3,600 $160.00
3,601 to 7,200 $220.00
Sewer - 1st 100' 55.00 7,201 and greater $309.00
Sewer - each additional 100' 46.40
Water Service - 1st 100' \ 55.00 Medical Gas Systems:
Water Service - each additional 100' \ 46.40
Valuation: Pere t Fee:
Storm & Rain Drain - 1st 100' 55.00 $1.00 to $5,000.00 Min urn fee $72.50
Storm & Rain Drain - each additional 100' \ 46.40 $5,001.00 to $10,000.00 $ .50 for the first $5,000.00 and $ 1.52 for each
Fixture or Item Qik Fee (ea) Total . dditional $100.00 or fraction thereof, to and
• including $10,000.00.
Commercial Back Flow Prevention Device \ 46.40 $10,001.00 to $25,000.01. $148.50 for the first $10,000.00 and $1.54 for
Residential Backflow Prevention Device each additional $100.00 or fraction thereof; to
(minimum permit fee $36.25) 7.55 and including $25,000.00.
Rain Drain, single family dwelling , .25 $25,001.00 to $50,110.00 $379.50 for the first $25,000.00 and $1.45 for
Inspection of existing plumbing or each additional $100.00 or fraction thereof, to
specially requested inspections - per hour 72.50 and including $50,000.00.
Subtotal: I $50,001.00 a • I up .$742.00 for the first $50,000.00 and $1.20 for
each.additional $100.00 or fraction thereof.
Fixture Work: Plan Review for Complex Structures
Are you capping, adding or replacing fixtures? If "yes", A "complex structure" is defined as an installation of a plumbing
please indicate work performed by fixture. Failure to system that meets any of the following criteria.
accurately report fixtures could result in increased sewer fees Please check all that apply. '
II
Quantity by (Fixture) Work Performed Any. new commercial building.
Fixture Type: Replace • Any new exterior plumbing site utilities.
Previous Capped Added Existin. ❑ • commercial building with installation, alteration or addition
Baptistry /Font o ine (9) or more new or relocated plumbing fixtures.
Bath - Tub /Shower ❑ Me.-'cal gas and vacuum systems for health care facilities
- Jacuzzi /Whirlpool • provi.'ng services to human beings.
Car Wash -Each Stall ❑ Plumbi • installations, alterations or additions to food service
-Drive Thru facilities . here new plumbing fixtures, including interceptors,
Cuspidor/Water Aspirator are being i .talled for the food service area.
Dishwasher - Commercial j ❑ Any new rest 'ential building containing three (3) or more
- Domestic / dwelling units.
Drinking Fountain
Eye Wash ❑ Any NFPA 13- 11 ultipurpose fire sprinkler system.
Floor Drain /sink 2" Submit 2 sets ■ plans with any of the above.
3" c-
•
Car Wash Drain / Isometric 1 Riser Diagram .
Garbage -Domestic l Isometric or riser diagra is required for new buildings
Disposal - Commercial /I three (3) or more stories i height.
- Industrial /
Ice Mach./Refrig. Drains /
Oil Separator (Gas Station) / Comments regarding fixture k:
Rec. Vehicle Dump Station /
Shower -Gang I
-Stall
Sink - Bar/Lavatory •
- Bradley .
- Commercial '
- Service •,
Swimming Pool Filter •
Washer - Clothes *Note: If the fixture work under this permit results in an
Water Extractor .
Water Closet - Toilet increase of sewer EDUs, a sewer permit will be'issued and
Urinal fees assessed for the sewer increase must be paid before the
Other Fixtures: plumbing permit can be issued.
. ,
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WASHINGTON COUNTY CASEF1LE 05-929 1 OF Ku# 2189
,L
CITY OF TIGARD
BUILDING DIVISION ,.. - PERMIT*: PLM2005-00531
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/27/2005
Phone: (503) 639-4171 /401 i r1\
_AJJ, A II
Inspection Requests (24 Hrs.): (503) 639-4175 ..„...... --
INSPECTION WORKSHEET FOR DATE: 10/28/2005 TIME: 7:18AM PAGE: 61
SITE ADDRESS: 09314 SW LEHMAN ST CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 008 TYPE OF USE:
PROJECT NAME: LEHMAN PARTITION EAST
DESCRIPTION: Site utilities for minor land partition.
OWNER: RICHARDS, DALE PHONE #: 503-780-4375
CONTRACTOR: NEW WEST CONSTRUCTORS INC PHONE #: 503-977-2909
Inspection Request Scheduled For: Date: 10/28/2005 Pour Time:
Code . # Inspection Description Confirm # Contact # Message
345 Culvert/catch basin 019700-02 503 780-4375 N
Corrections/Comments/Instructions:
Addi J / On f
1
- •VI ASS - - — 1:1 PARTIAL APPROVAL _ _ _ 0_ CANCEL 0 NO ACCESS _
El FAIL 0 CALL FOR INSPECTION 0 ADDITIONAL FEES ASSESSED
Inspector: 0, 0 Date: 0 / , kr Phone #: (503) 718-
. ,
1 .
CITY OF TIGAR.D
BUILDING DIVISION . . 4:-_ - PERMIT #: PLM2005-00531
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/27/2005
Phone: (503) 639-4171 "i/Apptillt
Inspection Requests (24 Hrs.): (503) 639-4175
INSPECTION WORKSHEET FOR DATE: 10/28/2005 TIME: 7:18AM PAGE: 63
SITE ADDRESS: 09314 SW LEHMAN ST CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 008 TYPE OF USE:
PROJECT NAME: LEHMAN PARTITION EAST
DESCRIPTION: Site utilities for minor land partition.
OWNER: RICHARDS, DALE PHONE #: 503-780-4375
CONTRACTOR: NEW WEST CONSTRUCTORS INC PHONE #: 503-97'7-2909
Inspection Request Scheduled For: Date: 10/28/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
340 Storm drain 019700-01 503 7;30-4375 Y
. Corrections/Comments/Instructions:
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-pi PASS PARTIAL APPROVAL - _ CANCEL FTNO ACCESS
I FAIL n CALL FOR INSPECTION El ADDITIONAL FEES ASSESSED
Inspector:, / PI' 1.-- -Date: Wo" I3 Phone #: (503) 718-
CITY OF TIGARD _
BUILDING DIVISION PERMIT #t: PLM2005-00531
13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: 10/27/2005
7ni
Phone: (503) 639 -4171 ar1101{I I ,
Inspection Requests (24 Hrs.): (503) 639 -4175 =.�
INSPECTION WORKSHEET FOR DATE: 12/20/2005 TIME: 7 :30AM PAGE: 20
SITE ADDRESS: U9314 SW LEHMAN ST CLASS OF WORK:
SUBDIVISION: LEHMANN ACRE TRACT LOT #: 000 TYPE OF USE:
PROJECT NAME: LEHMAN PARTITION EAST
DESCRIPTION: Site utilities for minor land partition.
OWNER: RICHARDS, DALE PHONE #: 503 -780 -4375
CONTRACTOR: NEW WEST CONSTRUCTORS INC PHONE #: 503.977 -2909
Inspection Request Scheduled For: Date: 12/20/2005 Pour Time:
Code # Inspection Description Confirm # Contact # Message
330 Water service 023779-01 503.969 -6019 N
Corrections/Comments/Instructions:
•
ellri
[PASS - 0-PARTIAL-APPROVAL- (_CANCEL ❑ - NO ACCESS
�❑
FAIL ❑ CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
/2„),) •
Inspector: t Date: 1 )) U f/ Phone #: (503) 718 - •
CITY OF TIGARD Ow
BUILDING DIVISION tt PERMIT #: PL M2006-00631
e
, 13125 SW Hall Blvd., Tigard, OR 97223 DATE ISSUED: l0/970006
Phone: (503) 639- 4171�Iptgt'�II
Inspection Requests (24 Hrs.): (503) 639 -4175 . �_��
INSPECTION WORKSHEET FOR DATE: 2/1612006 TIME: 7:0I7Am PAGE: 27
SITE ADDRESS: 09314 SW LEHMAN S T CLASS OF WORK:
SUBDIVISION: LI ~HMANN ACRE TRACT LOT #: 008 TYPE OF USE:
PROJECT NAME: LEHMAN PARTITION EAST
DESCRIPTION: Site utilities: for minor land partition.
OWNER: RICHARDS, DALE PHONE #: 50a.780.4376
CONTRACTOR: NEW WEST CONSTRUCTORS INC PHONE #: 503-977-2909
Inspection Request Scheduled For: Date: 1161-)006 Pour Time:
Code # Inspection Description Confirm # Contact # Message
/a
3f19 Plumbing final 027014-01 5103.9$9 -6307 N
Corrections /Comments /Instructions:
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,FAIL I I CALL FOR INSPECTION ❑ ADDITIONAL FEES ASSESSED
Inspector: ell ■ ..-t-- Date: 2 J I t lot Phone #: (503) 718-